January 2025 Insight Brief
The Billing Breakdown
Why members remain confused by their bills—and what to do about it
Executive Summary
Billing is one of the most persistent pain points in the healthcare experience. Despite efforts to consolidate statements or improve payment tools, most members still struggle to understand what they owe, why they owe it, and what’s covered by insurance.
In recent focus groups and surveys, patients expressed frustration not just with the complexity of their bills—but with the way it makes them feel: confused, intimidated, and unsupported. This brief distills key insights and offers practical strategies to simplify billing and strengthen trust.
Key Insight #1: Confusion Comes Before Consolidation
“I got three bills for one visit and had no idea what they were for.”
Members often receive multiple bills from different parts of the same visit (hospital, physician, lab)—with little to no explanation. While consolidated billing is a long-term goal, most members want clarity and consistency first.
- Participants frequently confused the Explanation of Benefits (EOB) with their actual bill.
- Item descriptions like “medical supplies” or “professional services” felt vague and suspicious.
- The presence of multiple logos or providers on one statement raised trust concerns.
💡 What to Do:
- Start with a visual, itemized summary: what was done, what insurance paid, what you owe.
- Align terminology across providers and EOBs.
Use a single brand voice across all statements.
Key Insight #2: Health Literacy Gaps Undermine the Experience
“If I advocate for myself, I get charged less. But not everyone knows how to do that.”
Patients—especially those who feel medically or financially vulnerable—report that understanding their bills feels like an uphill battle.
- Most participants were unfamiliar with terms like “MOOP,” “deductible met,” or “coinsurance.”
- Several said they’ve learned to call in and negotiate, reinforcing the idea that the bill is not final unless challenged.
- Participants who felt the least confident about medical terms reported the highest stress.
💡 What to Do:
- Replace acronyms with plain terms (e.g., “Out-of-Pocket Max” instead of MOOP).
- Add contextual help or pop-ups in digital billing interfaces.
Train billing advocates or digital chat assistants to provide real-time education.
Key Insight #3: Support Still Starts with a Human Voice
“When I have a question, I want to talk to someone who can actually help—not just read me the bill.”
Even when digital tools were available, participants still said they defaulted to calling because:
- They didn’t know the digital tools existed (e.g., Bill Pay platform).
- They didn’t trust they would find what they needed.
- They wanted a conversation—not another transaction.
💡 What to Do:
- Promote live support options clearly on every bill and billing page.
- Invest in support reps trained to resolve—not just explain—billing issues.
- Add “explain this bill” prompts in your app, portal, or chatbot flows.
Summary
Billing isn’t just about getting paid—it’s a major trust touchpoint. When members feel deceived, confused, or abandoned during the billing process, they carry that frustration into every future interaction with your health system or plan.
Redesigning the billing experience means addressing literacy, transparency, and the human need for clarity and care.